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JAMA Ophthalmology Clinical Challenge
February 6, 2020

Sudden Onset of Multiple Green Spots in the Eyes of a Woman With Breast Cancer

Author Affiliations
  • 1Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
JAMA Ophthalmol. 2020;138(4):412-413. doi:10.1001/jamaophthalmol.2019.5288

A 65-year-old white woman with stage IV breast cancer with metastases to the lungs and liver presented with a new onset of what she called “multiple green spots” in both eyes for 3 days. The spots were stationary; she denied any floaters or photopsias. The onset was simultaneous in both eyes, with no associated eye pain or photophobia. There was no ocular history, and a recent comprehensive eye examination had normal results. Her visual acuity was 20/20 OU. An anterior segment examination had unremarkable results. There was no vitritis, and her optic nerves were pink and sharp. A dilated fundus examination revealed multifocal, hypopigmented, cream-colored spots scattered throughout the posterior pole in both eyes. These spots were hyperautofluorescent on fundus autofluorescence and localized to the subretinal space (Figure 1). Notably, 2 weeks prior to presentation, she had started taking cobimetinib therapy as part of a clinical trial for her breast cancer.

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